There are myriad dangers present when first responders, whether police or EMS, arrive at any emergency scene. Typically they are walking into unfamiliar territory.

With a recent influx of designer drugs, namely synthetic opioids, responders are now dealing with additional stress from more calls and a range of potencies in drugs.

Overdoses are becoming commonplace in Racine County and around the nation, according to Chris Eberlein, medical adviser for the southwest region of the Department of Health Services. And he sees increased wear on EMS personnel.

With so little information, it is difficult to determine the correct treatment to combat the effects of the illegal drugs. With drugs like Narcan, which is used to reverse the effects of opiate substances, the drug is usually harmless even if administered to a patient that had not taken an opiate substance.

A problem arises when responders have to administer drugs that may not react well with whatever the patient used. This has become more of an issue with the national influx of designer drugs. The chemical compounds are similar, but when mixed to create a drug cocktail, the effects increase.

Even with Narcan sometimes, there isn’t a guarantee drugs like it will have the same reactions.

“It’s important for responders to know that designer-drug users may not respond to naloxone in the same way a heroin user would respond,” said Barry Logan, chief of forensic toxicology at NMS Labs in Pennsylvania.

Legal synthetics have caused "upwards of 50 deaths" nationwide during the last four months, according to Barry Logan, director of the Center of Forensic Science and Education. The center is the nonprofit research arm of NMS Labs, which tests for the substances at its Willow Grove headquarters.

NMS confirmed one death in Illinois caused by W-18 and is investigating its role in another.

"The bigger problem right now is the designer opioid U-47700 and the designer fentanyl, furanyl, fentanyl," Logan said, adding that NMS had detected the two substances in a string of fatal overdoses that reached from Florida to Maine.

In recent years there has been a sharp rise in heroin use and heroin overdoses. According to recent data from the National Institute on Drug Abuse (NIDA), a rise in heroin abuse in the United States has been associated with an increase in fatal overdoses. Furthermore, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued an alert about an increase in deaths related to the use of heroin laced with fentanyl.

Fentanyl is a powerful painkiller that is reported to be up to 100 times more potent than morphine, an active ingredient in heroin. Law enforcement from across the country have started to notice that some of the heroin they’ve seized has been laced with the painkiller, fentanyl. Heroin laced with fentanyl is a deadly mixture, especially since most users are unaware that the heroin has been tainted.

This is a significant public health concern. Many users unknowingly inject this potent drug combination and overdose as a result. For those lucky enough to make it to the hospital, treatment may come too little too late. Since most hospitals don’t screen for fentanyl, medical staff may believe that they are only treating a heroin overdose which is usually easier to reverse. More attention needs to be brought to the issue of fentanyl-laced heroin before it becomes a greater epidemic. Additionally, there is evidence that in some cases the heroin being sold is pure fentanyl without any heroin.

In reviewing our results for drug trends, we have found fentanyl to be more prevalent than ever before.

“After seeing the trend of increasing fentanyl use, we knew the best thing to do was to include fentanyl detection to all of our postmortem panels,” Said Dr. Barry Logan, Chief of Forensic Toxicology at NMS Labs.

In just 90 days we saw 88 cases positive for both fentanyl and 6-acetylmorphine (a unique metabolite of heroin) from across the country. You can view a chart of our findings along with a full report here.

NMS Labs, a leading international forensic and clinical reference laboratory, announces the branding of its DUID confirmatory testing results report—ProofPOSITIVE®, An NMS Labs Confirmation Report.

Awareness of the extent of involvement of both therapeutic and abused drugs in impaired driving investigations and fatal crashes continues to grow. The technology to complete the investigation, however, is often lacking, with inadequate testing being performed or lack of understanding of the implications of the drug test findings. NMS Labs has announced the release of its new branded drug confirmation test, ProofPOSITIVE®, to provide a targeted, economical solution to identifying the drugs or combinations of drugs that can account for impairment, and clear interpretive advice provided right on the report. Prepared based on a study of the most common drugs encountered in the Drug Recognition Expert (DRE) and Driving Under the Influence of Drugs (DUID) programs nationwide, ProofPOSITIVE® reinforces NMS Labs commitment to the DRE program, and its need for timely, intelligent, targeted, testing that is also economical.

Since not all tests are created equal, choosing a high-quality laboratory, well informed in the area of DUID testing is essential. NMS Labs ISO-level quality from leaders in forensic laboratories accreditation, ABFT and ASCLD-LAB, and it’s internationally recognized experts in DUID provide confidence to investigators that their tests are in the right hands.

The new test was developed by Dr. Barry Logan, nationally recognized for his leadership and contribution to the field of drug impaired driving. Logan explained, “We’ve added key new compounds to this test to reflect our discovery of the latest trends in drug use in vehicle fatalities and arrests. We expect that this will increase drug detection rates in DUID and vehicular crimes cases by about 10%.” In addition, Logan noted that the ProofPOSITIVE® service adds on testing for more exotic drugs in circumstances where the driver’s impairment cannot be accounted for by the initial screening results. NMS Labs experienced court qualified toxicologists review and sign each report, and provide testimony when required.

“We needed to tell our story better, and ProofPOSITIVE® is simply the right message to resonate with those needing a dependable, quality confirmatory report and interpretive advice on the meaning of results in the court setting,” noted Julie Ruth, Sr. Director of Marketing at NMS Labs

The ProofPOSITIVE® confirmation report reflects NMS Labs alignment with National Safety Council’s recent recommendations for DUID drug testing, providing police with the most relevant targeted approach to DUID testing as well as contributing to the growing momentum around the use of oral fluid as an accepted forensic sample in DUID investigations. Additional details can be found on NMS Labs website.

Road safety experts are hoping to uncover the next big breakthrough in reducing the road toll at T2013: The 20th International Council on Alcohol, Drugs and Traffic Safety conference to be held in Brisbane from August 25-28.

T2013 conference chair and director of CARRS-Q Professor Barry Watson said the conference, which brings together road safety experts from across the world, would tackle one of the major causes of road deaths and injury - drink and drug driving.

Professor Watson said "designer drugs" were the new face of drug abuse across the world.

"Research has shown new designer drugs that mimic drugs such as cannabis and amphetamines are being used at an unprecedented rate and are difficult to detect," he said.

"This is presenting a huge challenge and one that will be a major focus of the conference.

"Being a step ahead in the detection of designer drugs is crucial and we will have guest speakers including Marilyn Huestis from the National Institute on Drug Abuse and Barry Logan from the Centre for Forensic Science Research and Education to provide an insight into how we can overcome this challenge."

The ICADTS conference is regarded as the leading international meeting in the field of alcohol, drugs and traffic safety.

Methamphetamine is simple to make, if you know how to do it. The drug can be produced through various chemical processes that use household materials, such as Drano, lithium batteries, matches, lighter fluid and cold medication. The chemicals used from the items to make meth are called precursors.

“A lot of people think meth is dangerous because of all the chemicals that go into it, but that’s not necessarily true,” said Barry K. Logan, president of the American Academy of Forensic Sciences, during a phone interview with the Free Press. “All those chemicals can be toxic in themselves ... but together they create their own chemical, methamphetamine.”

Logan, who holds doctorates in both chemistry and forensic toxicology, is also the national director of NMS Labs, an independent forensic laboratory in Willow Grove, Pa., that specializes in new drug detection and forensic analysis for criminal justice and death investigation agencies.

Meth is a central nervous system stimulant, Logan said.

“Once the drug gets into the brain, it releases a cascade of brain chemicals inside the user,” he said. “Meth makes people think everything is moving fast around them. They get motor restlessness syndrome and they can’t stand still, they have to be constantly moving.”

Throughout his research, Logan found that many users reported a sense of contentment before the fall.

“Euphoria is gradually replaced with mounting anxiety, inability to concentrate, and delusions,” Logan wrote in an article about the effects of meth. “The user is anxious, irritable, short-tempered, and introspective. Pseudohallucinations can occur, and paranoia sets in.”

This tweaking phase may last for hours and repeat for days, known as bingeing.

If you’re a severe abuser, you may go on “runs” that could last as long as 30 days.

These runs, known scientifically as high-intensity binges, gradually deteriorate your state of mind and frequently end in a psychotic state, according to Logan’s article.

Aside from the mental disorders associated with meth abuse, the drug takes a deadly toll on the body as well. Chronic use of meth can lead to cardiovascular disease, liver disease, stroke, neurological complications (like seizures) and pulmonary problems (like pneumonia).

Addicts commonly have missing or fractured teeth and are subject to gum disease, according to a report written by Dr. Richard A. Rawson, associate director of the Integrated Substance Abuse Programs at UCLA.

Sexually transmitted diseases are also common among meth addicts due to increased risky sexual behaviors and other associated risk behaviors, such as sharing needles, while being on the drug, Rawson wrote.

Despite its lethal consequences, meth remains a staple crop of the drug industry and because of ongoing efforts to stop meth production, the hardcore drug continues to evolve.

The news media has documented a growing trend in gruesome and violent “zombie-like” attacks in recent weeks. In Miami, a man was shot and killed by police while eating the face of another man. In Louisiana, a man bit off a chunk of his neighbor’s cheek. A woman in New York attacked her own three-year old child and then attempted to sink her teeth into a police officer. In Texas, a man tried to eat his family’s dog while the animal was still alive.

Shortly after the Miami attack, Pennsylvania Congressman Pat Meehan, a former U.S. Attorney, convened a meeting of local law enforcement, forensic scientists, drug experts, and school officials in Upper Merion, Pa. The goal of the meeting was to discuss the challenges posed by designer drugs such as “bath salts” and synthetic marijuana, also commonly referred to as “fake pot.” Law enforcement officials noted that the biting and the animalistic behavior that occurred in Miami and other recent incidents is a common behavior exhibited by individuals high on bath salts.

The group discussed how these drugs are readily available and freely marketed online as household items like incense, plant food and bath salts. In some cases, they are sold in local neighborhoods at corner markets and gas stations. And although they typically have the disclaimer “not for human consumption” they are produced with the specific intention of being smoked or injected by people looking for a quick high.

A major concern is that the ease with which these drugs can be purchased on the internet has sparked a surge in use among teenagers. A recent study commissioned by the National Institute for Drug Abuse revealed that one in every nine high school seniors (11.4 percent) reported using synthetic marijuana in the prior 12 months. Many teens believe the products are safe, “legal” highs that will not be detected in a routine drug test, and will not arouse parental suspicion. Others appear to believe they are safer alternatives to marijuana and amphetamines such as cocaine, which they are designed to mimic. In reality, they appear to be far more dangerous.

Bath salts are known to cause agitation, paranoia, hallucinations, chest pain, suicidal tendencies, and the animalistic behavior shown in recent violent attacks. Synthetic marijuana poses its own risks because of the way it alters the brain’s chemistry and has been linked to numerous deaths. Last June, police said a teenager jumped off the roof of a mall parking garage in Willow Grove after smoking fake pot.

Given their misleading marketing, heightened availability, and adaptive “legality,” it is not surprising that last year Poison Control Centers received over thirteen thousand human exposure calls regarding synthetic cannabinoids and bath salts. Last year, the U.S. Drug Enforcement Administration took steps to ban the chemicals used to make these designer drugs. But many manufacturers responded by slightly altering the chemical makeup of the compounds, effectively skirting federal law. This led to a new round of increasingly volatile and dangerous drugs.

As Congressman Meehan and stakeholders discussed, addressing this growing problem requires a multi-pronged effort. From a legislative perspective, instead of reactively banning substances, lawmakers must proactively classify the new non-scheduled substances being constantly reformulated by manufacturers as analogs, making them illegal under federal law. Meehan said this must be accompanied by a focused effort to go after and take down the internet sites that peddle these dangerous drugs.

Similarly, we need a concerted education effort aimed not just at teenagers, but parents as well. They need to be informed about what these substances look like, how they are packaged and marketed, and the negative long and short-term effects of the substances which at best alter brain chemistry, and at worst induce violent behavior, and sometimes even death.

At the same time, we must work to expand our forensic testing capabilities to detect and identify the use of bath salts and synthetic marijuana. If we are able to detect the use of these drugs in blood and urine as easily as we can detect marijuana or cocaine, these synthetic drugs will cease to be an alternative for individuals who are seeking to evade detection in standard drug tests.

These synthetic drugs do not just pose a danger to abusers. They also endanger innocent bystanders, law enforcement, and anyone else an individual high on these substances may come in contact with. It is time to step up and tackle this problem head on.
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Dr. Barry Logan is Director of Forensic and Toxicological Services for NMS Labs, in Willow Grove, Pa. and is President-Elect of the American Academy of Forensic Sciences (AAFS). For more information on synthetic drugs, including a brochure for parents, visit www.nmslabs.com.

The Center for Forensic Science Research and Education, one of the main initiatives at the Fredric Rieders Family Renaissance Foundation, has received a grant from the National Safety Council in partnership with National Highway Traffic Safety Administration (NHTSA) to conduct a survey of laboratories performing testing in impaired driving cases in order to develop guidelines about what drugs should be tested for and what technologies should be used. The Center’s Executive Director Dr. Barry Logan, a leading authority in the forensic toxicology of impaired driving, said that “this is an important way to make sure that the needs of investigators are met by the laboratories that perform the drug and alcohol testing needed to relate driving impairment and accident involvement to use of drugs.” The survey will include information about both licit and illicit drugs, the laboratory’s capacity, how long it takes to get testing done, and how sensitive methods should be ensure detection. The survey will be followed by an expert panel meeting to finalize the recommendations and communicate them to the traffic safety and toxicology communities.

Dr. Barry Logan, Executive Director of The Fredric Rieders Family Renaissance Foundation and National Director of Forensic Services at NMS Labs, has been invited to participate in a Summit on Drugged Driving being hosted by Director Gil Kerlikowske, President Obama’s Drug Czar. The summit will focus on the rising public health and safety threat of drugged driving, and help coordinate the resources to help with its detection, investigation, prosecution, and intervention. Dr. Logan will bring a forensic toxicology focus to the group, and discuss issues regarding standardization of testing, use of appropriate technology and techniques for analysis, and the challenges of interpreting laboratory results. The summit will be held at the White House Conference Center on October 14th.